Provider Demographics
NPI:1902853807
Name:FUSCO, CHRISTOPHER (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:FUSCO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 EDEN WAY N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0602
Mailing Address - Country:US
Mailing Address - Phone:757-424-4177
Mailing Address - Fax:757-424-0496
Practice Address - Street 1:812 EDEN WAY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0602
Practice Address - Country:US
Practice Address - Phone:757-424-4177
Practice Address - Fax:757-424-0496
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA093345OtherBCBS
T83551Medicare UPIN
VAVAA102586Medicare PIN